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Logo of bmcpsycBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Psychiatry
 
BMC Psychiatry. 2012; 12: 172.
Published online 2012 October 17. doi:  10.1186/1471-244X-12-172
PMCID: PMC3502449
The feasibility and validity of ambulatory self-report of psychotic symptoms using a smartphone software application
Jasper E Palmier-Claus,corresponding author1,2 John Ainsworth,1 Matthew Machin,1 Cristine Barrowclough,2 Graham Dunn,1 Emma Barkus,3 Anne Rogers,1 Til Wykes,4 Shitij Kapur,4 Iain Buchan,1 Emma Salter,1 and Shôn W Lewis1
1School of Community Based Medicine, the University of Manchester, Oxford Road, Manchester, UK
2School of Psychology, The University of Manchester, Oxford Road, Manchester, UK
3School of Psychology, The University of Wollongong, Oxford Road, Manchester, UK
4Institute of Psychiatry, Kings College London, London, UK
corresponding authorCorresponding author.
Jasper E Palmier-Claus: Jasper.Palmier-Claus/at/manchester.ac.uk; John Ainsworth: John.Ainsworth/at/manchester.ac.uk; Matthew Machin: Matthew.Machin/at/manchester.ac.uk; Cristine Barrowclough: Christine.Barrowclough/at/manchester.ac.uk; Graham Dunn: Graham.Dunn/at/manchester.ac.uk; Emma Barkus: ebarkus/at/uow.edu.au; Anne Rogers: Anne.Rogers/at/manchester.ac.uk; Til Wykes: til.wykes/at/kcl.ac.uk; Shitij Kapur: Shitij.Kapur/at/kcl.ac.uk; Iain Buchan: Iain.Buchan/at/manchester.ac.uk; Emma Salter: Emma.Salter/at/student.manchester.ac.uk; Shôn W Lewis: Shon.Lewis/at/manchester.ac.uk
Received May 14, 2012; Accepted October 10, 2012.
Abstract
Background
Semi-structured interview scales for psychosis are the gold standard approach to assessing psychotic and other symptoms. However, such assessments have limitations such as recall bias, averaging, insensitivity to change and variable interrater reliability. Ambulant, real-time self-report assessment devices may hold advantages over interview measures, but it needs to be shown that the data thus collected are valid, and the collection method is acceptable, feasible and safe. We report on a monitoring system for the assessment of psychosis using smartphone technology. The primary aims were to: i) assess validity through correlations of item responses with those on widely accepted interview assessments of psychosis, and ii) examine compliance to the procedure in individuals with psychosis of varying severity.
Methods
A total of 44 participants (acute or remitted DSM-4 schizophrenia and related disorders, and prodromal) completed 14 branching self-report items concerning key psychotic symptoms on a touch-screen mobile phone when prompted by an alarm at six pseudo-random times, each day, for one week. Face to face PANSS and CDS interviews were conducted before and after the assessment period blind to the ambulant data.
Results
Compliance as defined by completion of at least 33% of all possible data-points over seven days was 82%. In the 36 compliant participants, 5 items (delusions, hallucinations, suspiciousness, anxiety, hopelessness) showed moderate to strong (rho 0.6-0.8) associations with corresponding items from interview rating scales. Four items showed no significant correlation with rating scales: each was an item based on observable behaviour. Ambulant ratings showed excellent test-retest reliability and sensitivity to change.
Conclusions
Ambulatory monitoring of symptoms several times daily using smartphone software applications represents a feasible and valid way of assessing psychotic phenomena for research and clinical management purposes. Further evaluation required over longer assessment periods, in clinical trials and service settings.
Keywords: Mobile-phone, Psychosis, Assessment, Ambulant, Schizophrenia
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